Towards Predicting 30-Day Readmission among Oncology Patients: Identifying Timely and Actionable Risk Factors

Purpose: Predicting 30-day readmission risk is paramount to improving the quality of patient care. Previous studies have examined clinical risk factors associated with hospital readmissions. In this study, we compare sets of patient, provider, and community-level variables that are available at two different points of a patient's inpatient encounter (first 48 hours and the full encounter) to train readmission prediction models in order to identify and target appropriate actionable interventions that can potentially reduce avoidable readmissions. Methods: Using EHR data from a retrospective cohort of 2460 oncology patients, two sets of binary classification models predicting 30-day readmission were developed; one trained on variables that are available within the first 48 hours of admission and another trained on data from the entire hospital encounter. A comprehensive machine learning analysis pipeline was leveraged including preprocessing and feature transformation, feature importance and selection, machine learning modeling, and post-analysis. Results: Leveraging all features, the LGB (light gradient boosted machines) model produced higher, but comparable performance: (AUC: 0.711 and APS: 0.225) compared to Epic (AUC: 0.697 and APS: 0.221). Given features in the first 48-hours, the random forest model produces higher AUC (0.684), but lower PRC (0.18) and APS (0.184) than the Epic model (AUC: 0.676). In terms of the characteristics of patients flagged by these models, both the full LGB and 48-hour (random forest) feature models were highly sensitive in flagging more patients than the Epic models. Both models flagged patients with a similar distribution of race and sex; however, our LGB and random forest models more inclusive flagging more patients among younger age groups. The Epic models were more sensitive to identifying patients with an average lower zip income. Our 48-hour models were powered by novel features at various levels: patient (weight changeover 365 days, depression symptoms, laboratory values, cancer type), provider (winter discharge, hospital admission type), community (zip income, marital status of partner). Conclusion: We demonstrated that we could develop and validate models comparable to existing Epic 30-day readmission models, but provide several actionable insights that could create service interventions deployed by the case management or discharge planning teams that may decrease readmission rates over time.

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Development of Prediction Models Using Machine Learning Algorithms for Girls with Suspected Central Precocious Puberty: Retrospective Study (Preprint)

10.2196/preprints.11728 ◽

2018 ◽

Author(s):

Liyan Pan ◽

Guangjian Liu ◽

Xiaojian Mao ◽

Huixian Li ◽

Jiexin Zhang ◽

...

Keyword(s):

Machine Learning ◽

Retrospective Study ◽

Random Forest ◽

Precocious Puberty ◽

Prediction Models ◽

Central Precocious Puberty ◽

Machine Learning Algorithms ◽

Stimulation Test ◽

Gnrh Analogue ◽

Prediction Probability

BACKGROUND Central precocious puberty (CPP) in girls seriously affects their physical and mental development in childhood. The method of diagnosis—gonadotropin-releasing hormone (GnRH)–stimulation test or GnRH analogue (GnRHa)–stimulation test—is expensive and makes patients uncomfortable due to the need for repeated blood sampling. OBJECTIVE We aimed to combine multiple CPP–related features and construct machine learning models to predict response to the GnRHa-stimulation test. METHODS In this retrospective study, we analyzed clinical and laboratory data of 1757 girls who underwent a GnRHa test in order to develop XGBoost and random forest classifiers for prediction of response to the GnRHa test. The local interpretable model-agnostic explanations (LIME) algorithm was used with the black-box classifiers to increase their interpretability. We measured sensitivity, specificity, and area under receiver operating characteristic (AUC) of the models. RESULTS Both the XGBoost and random forest models achieved good performance in distinguishing between positive and negative responses, with the AUC ranging from 0.88 to 0.90, sensitivity ranging from 77.91% to 77.94%, and specificity ranging from 84.32% to 87.66%. Basal serum luteinizing hormone, follicle-stimulating hormone, and insulin-like growth factor-I levels were found to be the three most important factors. In the interpretable models of LIME, the abovementioned variables made high contributions to the prediction probability. CONCLUSIONS The prediction models we developed can help diagnose CPP and may be used as a prescreening tool before the GnRHa-stimulation test.

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Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.859 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 268-269

Author(s):

Jaime Speiser ◽

Kathryn Callahan ◽

Jason Fanning ◽

Thomas Gill ◽

Anne Newman ◽

...

Keyword(s):

Machine Learning ◽

Older Adults ◽

Random Forest ◽

Decision Tree ◽

Prediction Models ◽

Receiver Operating Curve ◽

Learning Methods ◽

Life Study ◽

Fall Injury ◽

Machine Learning Methods

Abstract Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty understanding the complex algorithms behind models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated in data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). Machine learning methods may offer improved performance compared to traditional models for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.

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Machine Learning-Based Prediction of Air Quality

Applied Sciences ◽

10.3390/app10249151 ◽

2020 ◽

Vol 10 (24) ◽

pp. 9151

Author(s):

Yun-Chia Liang ◽

Yona Maimury ◽

Angela Hsiang-Ling Chen ◽

Josue Rodolfo Cuevas Juarez

Keyword(s):

Machine Learning ◽

Air Quality ◽

Random Forest ◽

Prediction Models ◽

Superior Performance ◽

Support Vector ◽

Economic Activities ◽

Adaptive Boosting ◽

Series Of Experiments ◽

Artificial Neural Network Ann

Air, an essential natural resource, has been compromised in terms of quality by economic activities. Considerable research has been devoted to predicting instances of poor air quality, but most studies are limited by insufficient longitudinal data, making it difficult to account for seasonal and other factors. Several prediction models have been developed using an 11-year dataset collected by Taiwan’s Environmental Protection Administration (EPA). Machine learning methods, including adaptive boosting (AdaBoost), artificial neural network (ANN), random forest, stacking ensemble, and support vector machine (SVM), produce promising results for air quality index (AQI) level predictions. A series of experiments, using datasets for three different regions to obtain the best prediction performance from the stacking ensemble, AdaBoost, and random forest, found the stacking ensemble delivers consistently superior performance for R2 and RMSE, while AdaBoost provides best results for MAE.

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Development and validation of a difficult laryngoscopy prediction model using machine learning of neck circumference and thyromental height

BMC Anesthesiology ◽

10.1186/s12871-021-01343-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jong Ho Kim ◽

Haewon Kim ◽

Ji Su Jang ◽

Sung Mi Hwang ◽

So Young Lim ◽

...

Keyword(s):

Machine Learning ◽

Random Forest ◽

Confidence Interval ◽

Neck Circumference ◽

Difficult Laryngoscopy ◽

Gradient Boosting ◽

Test Set ◽

Equal Distribution ◽

Light Gradient ◽

Extreme Gradient Boosting

Abstract Background Predicting difficult airway is challengeable in patients with limited airway evaluation. The aim of this study is to develop and validate a model that predicts difficult laryngoscopy by machine learning of neck circumference and thyromental height as predictors that can be used even for patients with limited airway evaluation. Methods Variables for prediction of difficulty laryngoscopy included age, sex, height, weight, body mass index, neck circumference, and thyromental distance. Difficult laryngoscopy was defined as Grade 3 and 4 by the Cormack-Lehane classification. The preanesthesia and anesthesia data of 1677 patients who had undergone general anesthesia at a single center were collected. The data set was randomly stratified into a training set (80%) and a test set (20%), with equal distribution of difficulty laryngoscopy. The training data sets were trained with five algorithms (logistic regression, multilayer perceptron, random forest, extreme gradient boosting, and light gradient boosting machine). The prediction models were validated through a test set. Results The model’s performance using random forest was best (area under receiver operating characteristic curve = 0.79 [95% confidence interval: 0.72–0.86], area under precision-recall curve = 0.32 [95% confidence interval: 0.27–0.37]). Conclusions Machine learning can predict difficult laryngoscopy through a combination of several predictors including neck circumference and thyromental height. The performance of the model can be improved with more data, a new variable and combination of models.

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Machine Learning-based in-hospital Mortality Prediction Models for Patients With Acute Coronary Syndrome

10.21203/rs.3.rs-134944/v1 ◽

2020 ◽

Author(s):

Jun Ke ◽

Yiwei Chen ◽

Xiaoping Wang ◽

Zhiyong Wu ◽

qiongyao Zhang ◽

...

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Random Forest ◽

Hospital Mortality ◽

Operating Characteristic ◽

Prediction Models ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Hdl Cholesterol ◽

Coronary Syndrome

Abstract BackgroundThe purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models.MethodsThe data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model.ResultsA total of 7810 ACS patients were included in the study, and the in-hospital mortality rate was 1.75%. Multivariate logistic regression analysis found that age and levels of D-dimer, cardiac troponin I, N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactate dehydrogenase (LDH), high-density lipoprotein (HDL) cholesterol, and calcium channel blockers were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.963, 0.960, 0.963, and 0.959, respectively. Feature importance evaluation found that NT-proBNP, LDH, and HDL cholesterol were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model.ConclusionsThe predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, LDH, and HDL cholesterol, as this may improve the clinical outcomes of ACS patients.

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Abstract 196: Development and Validation of Machine Learning-based Race-specific Models to Predict 10-year Risk of Heart Failure: A Multi-cohort Analysis

Circulation ◽

10.1161/circ.142.suppl_3.196 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Matthew W Segar ◽

Byron Jaeger ◽

Kershaw V Patel ◽

Vijay Nambi ◽

Chiadi E Ndumele ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Heart Failure ◽

Risk Prediction ◽

Prediction Models ◽

External Validation ◽

Superior Performance ◽

Risk Models ◽

Black And White ◽

White Adults

Introduction: Heart failure (HF) risk and the underlying biological risk factors vary by race. Machine learning (ML) may improve race-specific HF risk prediction but this has not been fully evaluated. Methods: The study included participants from 4 cohorts (ARIC, DHS, JHS, and MESA) aged > 40 years, free of baseline HF, and with adjudicated HF event follow-up. Black adults from JHS and white adults from ARIC were used to derive race-specific ML models to predict 10-year HF risk. The ML models were externally validated in subgroups of black and white adults from ARIC (excluding JHS participants) and pooled MESA/DHS cohorts and compared to prior established HF risk scores developed in ARIC and MESA. Harrell’s C-index and Greenwood-Nam-D’Agostino chi-square were used to assess discrimination and calibration, respectively. Results: In the derivation cohorts, 288 of 4141 (7.0%) black and 391 of 8242 (4.7%) white adults developed HF over 10 years. The ML models had excellent discrimination in both black and white participants (C-indices = 0.88 and 0.89). In the external validation cohorts for black participants from ARIC (excluding JHS, N = 1072) and MESA/DHS pooled cohorts (N = 2821), 131 (12.2%) and 115 (4.1%) developed HF. The ML model had adequate calibration and demonstrated superior discrimination compared to established HF risk models (Fig A). A consistent pattern was also observed in the external validation cohorts of white participants from the MESA/DHS pooled cohorts (N=3236; 100 [3.1%] HF events) (Fig A). The most important predictors of HF in both races were NP levels. Cardiac biomarkers and glycemic parameters were most important among blacks while LV hypertrophy and prevalent CVD and traditional CV risk factors were the strongest predictors among whites (Fig B). Conclusions: Race-specific and ML-based HF risk models that integrate clinical, laboratory, and biomarker data demonstrated superior performance when compared to traditional risk prediction models.

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Survival prediction models since liver transplantation - comparisons between Cox models and machine learning techniques

BMC Medical Research Methodology ◽

10.1186/s12874-020-01153-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Georgios Kantidakis ◽

Hein Putter ◽

Carlo Lancia ◽

Jacob de Boer ◽

Andries E. Braat ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Neural Networks ◽

Liver Transplantation ◽

Prediction Models ◽

Machine Learning Techniques ◽

Brier Score ◽

Cox Models ◽

Learning Techniques ◽

Random Survival Forest

Abstract Background Predicting survival of recipients after liver transplantation is regarded as one of the most important challenges in contemporary medicine. Hence, improving on current prediction models is of great interest.Nowadays, there is a strong discussion in the medical field about machine learning (ML) and whether it has greater potential than traditional regression models when dealing with complex data. Criticism to ML is related to unsuitable performance measures and lack of interpretability which is important for clinicians. Methods In this paper, ML techniques such as random forests and neural networks are applied to large data of 62294 patients from the United States with 97 predictors selected on clinical/statistical grounds, over more than 600, to predict survival from transplantation. Of particular interest is also the identification of potential risk factors. A comparison is performed between 3 different Cox models (with all variables, backward selection and LASSO) and 3 machine learning techniques: a random survival forest and 2 partial logistic artificial neural networks (PLANNs). For PLANNs, novel extensions to their original specification are tested. Emphasis is given on the advantages and pitfalls of each method and on the interpretability of the ML techniques. Results Well-established predictive measures are employed from the survival field (C-index, Brier score and Integrated Brier Score) and the strongest prognostic factors are identified for each model. Clinical endpoint is overall graft-survival defined as the time between transplantation and the date of graft-failure or death. The random survival forest shows slightly better predictive performance than Cox models based on the C-index. Neural networks show better performance than both Cox models and random survival forest based on the Integrated Brier Score at 10 years. Conclusion In this work, it is shown that machine learning techniques can be a useful tool for both prediction and interpretation in the survival context. From the ML techniques examined here, PLANN with 1 hidden layer predicts survival probabilities the most accurately, being as calibrated as the Cox model with all variables. Trial registration Retrospective data were provided by the Scientific Registry of Transplant Recipients under Data Use Agreement number 9477 for analysis of risk factors after liver transplantation.

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Classification models using circulating neutrophil transcripts can detect unruptured intracranial aneurysm

Journal of Translational Medicine ◽

10.1186/s12967-020-02550-2 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Kerry E. Poppenberg ◽

Vincent M. Tutino ◽

Lu Li ◽

Muhammad Waqas ◽

Armond June ◽

...

Keyword(s):

Machine Learning ◽

Random Forest ◽

Prediction Models ◽

Model Performance ◽

Supervised Machine Learning ◽

Support Vector ◽

Learning Methods ◽

Training Cohort ◽

Network Analyses ◽

Machine Learning Methods

Abstract Background Intracranial aneurysms (IAs) are dangerous because of their potential to rupture. We previously found significant RNA expression differences in circulating neutrophils between patients with and without unruptured IAs and trained machine learning models to predict presence of IA using 40 neutrophil transcriptomes. Here, we aim to develop a predictive model for unruptured IA using neutrophil transcriptomes from a larger population and more robust machine learning methods. Methods Neutrophil RNA extracted from the blood of 134 patients (55 with IA, 79 IA-free controls) was subjected to next-generation RNA sequencing. In a randomly-selected training cohort (n = 94), the Least Absolute Shrinkage and Selection Operator (LASSO) selected transcripts, from which we constructed prediction models via 4 well-established supervised machine-learning algorithms (K-Nearest Neighbors, Random Forest, and Support Vector Machines with Gaussian and cubic kernels). We tested the models in the remaining samples (n = 40) and assessed model performance by receiver-operating-characteristic (ROC) curves. Real-time quantitative polymerase chain reaction (RT-qPCR) of 9 IA-associated genes was used to verify gene expression in a subset of 49 neutrophil RNA samples. We also examined the potential influence of demographics and comorbidities on model prediction. Results Feature selection using LASSO in the training cohort identified 37 IA-associated transcripts. Models trained using these transcripts had a maximum accuracy of 90% in the testing cohort. The testing performance across all methods had an average area under ROC curve (AUC) = 0.97, an improvement over our previous models. The Random Forest model performed best across both training and testing cohorts. RT-qPCR confirmed expression differences in 7 of 9 genes tested. Gene ontology and IPA network analyses performed on the 37 model genes reflected dysregulated inflammation, cell signaling, and apoptosis processes. In our data, demographics and comorbidities did not affect model performance. Conclusions We improved upon our previous IA prediction models based on circulating neutrophil transcriptomes by increasing sample size and by implementing LASSO and more robust machine learning methods. Future studies are needed to validate these models in larger cohorts and further investigate effect of covariates.

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Predicting mortality in hemodialysis patients using machine learning analysis

Clinical Kidney Journal ◽

10.1093/ckj/sfaa126 ◽

2020 ◽

Author(s):

Victoria Garcia-Montemayor ◽

Alejandro Martin-Malo ◽

Carlo Barbieri ◽

Francesco Bellocchio ◽

Sagrario Soriano ◽

...

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Random Forest ◽

Prediction Models ◽

Initial Period ◽

Area Under The Curve ◽

Mortality Prediction ◽

Machine Learning Techniques ◽

Prediction Of Mortality ◽

Mortality Prediction Models

Abstract Background Besides the classic logistic regression analysis, non-parametric methods based on machine learning techniques such as random forest are presently used to generate predictive models. The aim of this study was to evaluate random forest mortality prediction models in haemodialysis patients. Methods Data were acquired from incident haemodialysis patients between 1995 and 2015. Prediction of mortality at 6 months, 1 year and 2 years of haemodialysis was calculated using random forest and the accuracy was compared with logistic regression. Baseline data were constructed with the information obtained during the initial period of regular haemodialysis. Aiming to increase accuracy concerning baseline information of each patient, the period of time used to collect data was set at 30, 60 and 90 days after the first haemodialysis session. Results There were 1571 incident haemodialysis patients included. The mean age was 62.3 years and the average Charlson comorbidity index was 5.99. The mortality prediction models obtained by random forest appear to be adequate in terms of accuracy [area under the curve (AUC) 0.68–0.73] and superior to logistic regression models (ΔAUC 0.007–0.046). Results indicate that both random forest and logistic regression develop mortality prediction models using different variables. Conclusions Random forest is an adequate method, and superior to logistic regression, to generate mortality prediction models in haemodialysis patients.

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rSeqTU – a machine-learning based R package for prediction of bacterial transcription units

10.1101/553057 ◽

2019 ◽

Author(s):

Sheng-Yong Niu ◽

Binqiang Liu ◽

Qin Ma ◽

Wen-Chi Chou

Keyword(s):

Machine Learning ◽

Random Forest ◽

Regulatory Networks ◽

Prediction Models ◽

R Package ◽

Transcription Unit ◽

Support Vector ◽

Rna Seq ◽

Accurate Identification ◽

Prediction Approach

AbstractA transcription unit (TU) is composed of one or multiple adjacent genes on the same strand that are co-transcribed in mostly prokaryotes. Accurate identification of TUs is a crucial first step to delineate the transcriptional regulatory networks and elucidate the dynamic regulatory mechanisms encoded in various prokaryotic genomes. Many genomic features, e.g., gene intergenic distance, and transcriptomic features including continuous and stable RNA-seq reads count signals, have been collected from a large amount of experimental data and integrated into classification techniques to computationally predict genome-wide TUs. Although some tools and web servers are able to predict TUs based on bacterial RNA-seq data and genome sequences, there is a need to have an improved machine-learning prediction approach and a better comprehensive pipeline handling QC, TU prediction, and TU visualization. To enable users to efficiently perform TU identification on their local computers or high-performance clusters and provide a more accurate prediction, we develop an R package, named rSeqTU. rSeqTU uses a random forest algorithm to select essential features describing TUs and then uses support vector machine (SVM) to build TU prediction models. rSeqTU (available at https://s18692001.github.io/rSeqTU/) has six computational functionalities including read quality control, read mapping, training set generation, random-forest-based feature selection, TU prediction, and TU visualization.

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